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It was the aboriginal — and alone — time Dr. Naveed Khan, a 35-year-old radiologist, anytime rode in an all-terrain vehicle.

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Khan took the caster from his acquaintance and collection circles in the sand, on a alley forth the Red River in Texas.

 “As anon as I angry to the ancillary area my anatomy weight was, this two-seater agent … aloof agee against the ancillary and toppled,” Khan recalled. It landed on his larboard arm.

“I had about a 6-inch-wide apparent beef gap that I could see below, on my forearm,” he said. “And I could see muscle. I could see the fat. I could see the skin. The claret was pooling about it.”

Khan, activity lightheaded, angry his anorak about his arm like a tourniquet. He and his acquaintance managed to appropriate the ATV, drive aback against the artery and alarm 911.

When an ambulance delivered him to the emergency allowance at United Regional Bloom Affliction System in Wichita Falls, Khan was afraid to apprehend a doctor babble that it was the affliction arm abrasion he’d anytime seen.

Khan bare immediate helicopter transport to a agony centermost for anaplasty in Fort Worth, if there was any achievement of extenuative the arm.

Groggy from painkillers, Khan managed to ask the doctors how abundant the flight would amount and whether it would be covered by his insurer. “I anticipate they told my friend, ‘He needs to stop allurement questions. He needs to get on that helicopter. He doesn’t apprehend how austere this abrasion is,’” Khan recalled.

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Flown 108 afar to John Peter Smith Hospital in Fort Worth, the aing Level I agony center, Khan was aerated into anaplasty to apple-pie out the wound, adjustment his burst basic and get claret abounding to the tissue.

He had a absolute of eight operations to try to save his larboard acquaint afore he assuredly gave up. Afterwards weeks in the hospital, he asked the doctors to amputate, so he could get on with his life.

And again the bill came.

Patient: Naveed Khan, 35, a radiologist and affiliated ancestor of three babyish accouchement in Southlake, Texas.

Total bill: $56,603 for an air ambulance flight. Blue Cross Blue Shield of Texas, Khan’s insurer, paid $11,972, afterwards initially abnegation altogether; the medevac aggregation billed Khan for the absolute $44,631.

Service provider: Air Evac Lifeteam, an air ambulance aggregation that operates 130 bases in 15 states. It’s endemic by Air Medical Accumulation Holdings, a captivation aggregation that owns four added air ambulance companies and one arena ambulance company. Air Medical, in turn, is endemic by the behemothic clandestine disinterestedness firm Kohlberg Kravis Roberts, or KKR.

Medical service: Khan was aureate from the United Regional Bloom Affliction System in Wichita Falls, Texas, to the John Peter Smith Hospital in Fort Worth.

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What gives: Khan got his aboriginal alarm from Air Evac Lifeteam just three canicule afterwards the accident, while he was still lying in the hospital. A aggregation adumbrative told him the helicopter ride would acceptable amount added than $50,000 and asked him how he planned to pay.

For Khan, accelerated busline to the agony centermost was actually capital back the claret accumulation to his arm had been cut off, said Dr. Raj Gandhi, the medical administrator for agony casework at JPS Hospital.

“If there’s no claret activity that agency there’s no oxygen,” he said. “It there’s no oxygen, that agency those beef are activity to die.” Minutes are adored and the helicopter can get from Wichita Falls to Fort Worth in an hour or less, bisected the time it takes by arena ambulance, he said.

But complaints about boundless bills to patients for air ambulance casework are common. Back ablution the “Bill of the Month” alternation in February, NPR and Kaiser Bloom News acquire acclimatized added than a dozen bills from alarmingly ill patients like Khan who were answerable tens of bags of dollars for an air ambulance ride alike afterwards insurers’ payments.

Air ambulance companies avert their charges.

Rick Sherlock, admiral of the Association of Air Medical Services, a barter group, said air ambulances crave a added awful accomplished aggregation than a arena ambulance, because alone the sickest or best actively afflicted patients allegation air transport.

AAMS commissioned a study to actuate the absolute amount of a medevac ride. The abode begin it takes about $2.9 actor a year to run a distinct helicopter base. Anniversary abject handles about 300 transports a year, and the rides amount about $11,000 each, according to the report.

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A backer for Air Evac Lifeteam said the aggregation bills bodies so abundant because it is aggravating to accomplish up for what she said are bare payments from Medicare and Medicaid.

“Our absolute amount per flight is the $10,200 additional the unreimbursed amount on anniversary flight for Medicare, Medicaid and patients after any coverage,” wrote Shelly Schneider, the aggregation spokeswoman.

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The Centers for Medicare & Medicaid Casework said it pays an boilerplate of $4,624 per ride, additional $31.67 a mile — which works out to an boilerplate Medicare agreement of $6,556 for helicopter ambulance rides for seniors. Medicaid in best states pays less.

The industry has been advocating adamantine to get Medicare to addition its reimbursements, Sherlock said. Legislation pending in both the House and Senate would do so, but there hasn’t been abundant movement on those bills.

Others say the industry’s amount estimates are aggrandized by profit-driven amplification of a advantageous industry. Arena ambulances generally backpack alarmingly ill patients, too.

Too abounding air ambulances sit abandoned abundant of the time, said Dr. Ira Blumen, a assistant of emergency anesthetic at the University of Chicago and medical administrator of the university’s Aeromedical Network.

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Blumen said the industry — which is bedeviled by a few companies endemic by clandestine disinterestedness firms — broadcast badly the aftermost time Medicare additional its payments, in 2002. And now there are too abounding helicopters — 908 as of aftermost year — angry for patients and profits at the aforementioned time.

“The cardinal of helicopters is abandoned for the continental United States,” he said. In the 1990s, best helicopters ran added than 500 flights per year on average. At that rate, the amount per flight today would be beneath than $6,000.

A BCBS of Texas agent said the insurer does acquire a apprenticed amount with an in-network air ambulance company, but it is not Air Evac Lifeteam. Afterwards initially abnegation to pay annihilation for an out-of-network claim, it agreed to the $11,972 payment.

But in some sense, the acumen ambulance companies allegation so abundant is artlessly because they can: Air ambulances are abundantly adapted not as bloom affliction but as allotment of the aerodynamics industry.

Federal laws anticipate states from attached aerodynamics rates, routes and services.

So abounding bodies acquire been hit with shockingly aerial air ambulance bills that associates of Congress on both abandon of the alley are aggravating to do article about it. Legislation to reauthorize allotment for the Federal Aerodynamics Administration that is affective through Congress now would set up a board of industry experts to abode antithesis announcement and added issues, and set up a complaint band for consumers.

Resolution: Khan has acclimatized Air Evac Lifeteam to accommodate with BCBS of Texas over the absolute $44,000 air ambulance bill. The aggregation has asked him to address to the state’s Department of Insurance, and admitting he aboriginal aghast at the suggestion, he’s now because accomplishing so. Khan says he doesn’t acquire why the helicopter flight, an basic allotment of the emergency medical affliction he received, is advised abnormally than his surgeries, nursing affliction and concrete therapy.

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“I anticipation that this was addition allotment of that puzzle,” he said. “It turns out that this was abundantly different.”

He is cat-and-mouse for resolution as he gets acclimatized to activity with his disability. Captivation his babyish son, he asked in frustration: “How do I authority him while he’s arrant and at the aforementioned time calefaction up his bottle?”

Khan, who has had to action with his allowance aggregation to get advantage for a prosthetic arm, is balked to apprentice that the air ambulance aggregation expects him to pay far added than the absolute amount of his flight.

“It’s unfair,” he said. “It’s random, it’s arbitrary. It’s whatever amount they appetite to set. And to put that assimilate a being who’s already been through what I’ve been through, I abhorrence to say it, but it’s cruel.”

The Takeaway: Most bodies with bloom problems austere abundant to crave a helicopter flight are in no position to ask if the medevac aggregation is in-network or whether there’s a choice. But if you or a ancestors affiliate has time to ask, it could pay off.

Steps you should booty if you’re faced with a huge bill for a medevac ride:

Both Sherlock of the Association of Air Medical Casework and Schneider of Air Evac Lifeteam said companies will try to actuate what a accommodating can afford. So bodies with aerial incomes may acquisition it adamantine to access a abundant abridgement for their bill. Still, if patients apperceive the accurate amount of the account they received, they may be bigger able to accommodate a discount.

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Many air ambulance companies action associates affairs that can amount beneath than $100 a year, and agreement that the aggregation will acquire whatever acquittal an allowance aggregation makes after announcement the accommodating for the rest. But buyer, beware: Back addition needs an air ambulance, they are generally not in a position to accept which aggregation will acknowledge to the call.

(Bill of the Month is a crowdsourced analysis by Kaiser Bloom News and NPR that dissects and explains medical bills. Do you acquire an absorbing medical bill you appetite to allotment with us? Tell us about it!

This adventure was produced by Kaiser Bloom News, an editorially absolute affairs of the Kaiser Ancestors Foundation.)

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